Since its inception 97 years ago as the first multispecialty medical group in San Diego, Sharp Rees-Stealy has always been an innovative and forward-thinking organization.
As part of Sharp HealthCare, Sharp Rees-Stealy is one of the largest groups in San Diego with 694 doctors and advance practice providers supported by nearly 2,700 staff in 22 clinics across the county. In a matter of weeks, all departments in this large organization were thrust into using virtual options to provide care to patients due to the COVID-19 crisis; as were many ambulatory groups across the country.
With this shift to video and phone visits, more than 80 percent of our visits at Sharp Rees-Stealy are now performed virtually. Before COVID-19 that number was 3 percent. We are doing more than 2,400 video or phone visits a day across 34 medical and surgical specialties (nearly a 4,000 percent increase from pre-COVID days). The response from patients and care teams has been overwhelmingly positive.
Even though Sharp Rees-Stealy has been providing telemedicine visits since 2015, this rapid shift to nearly all care being provided through video and phone visits seemed as if it happened overnight. This drastic change created a situation that left our departments, doctors and staff to explore innovative ways of delivering an exceptional patient care experience. The innovation has been endless and absolutely inspiring to be a part of but has also presented some challenges. As one would imagine, rapid innovation presents challenges in harnessing best practices and processes that emerge from front-line teams across a large group practice.
Here are seven things to consider when designing, optimizing, and implementing virtual workflows in an ambulatory environment:
1. No need to be fancy - just get started: Begin with one department or specialty. You don’t need the Ferrari of video platforms to provide extraordinary patient care. In fact, you can even use a rotary phone. Just get started and focus on incremental improvement. With the COVID-19 crisis and loosened reimbursement and regulatory requirements, many organizations have turned to free video platforms in order to meet patient needs. Thanks to our forward-thinking leaders, we were well on our way toward integrating virtual care into our delivery model.
2. Begin with a vision: Challenge current thinking and be bold. Design a vision that lays out what the virtual patient and care team experience should look like (proof of concept). When designing the vision, think about the entire value stream from setting appointments, to pre-visit work, to check-in, to the actual visit and follow-up care. A good home always begins with a thoughtfully designed blueprint.
3. Keep the patient at the center: Doctors and care teams are learning to interact with and treat patients in new ways - as the vision and processes are designed, it is imperative teams focus on the patient experience and delivering high quality care. Remove the waste and focus on delivering value to patients.
4. Engage the front-line teams: Those who do the work, create the work. It is critical that you have a multidisciplinary team involved in this process including but not limited to doctors, clinical staff, administration, IT, of course, and other support teams. They are the experts.
5. Focus on the process: This is where the proof of concept or vision comes to life - leveraging process to optimize technology. During this process, the focus should be on identifying and developing standard work documentation to help operationalize the vision. Investing the proper amount of time here to ensure everything is well documented will help with deployment and training in the future. Standard work is the building block for continuous improvement.
6. Pilot the new workflow: Run a pilot focused on learning fast and adjusting quickly; then focus on spread. I always advise teams, “go slow to go fast”.
7. Continuous improvement: This is just the beginning. It is important to have established forums and mechanisms to continuously check in with the teams and improve on the standard work. Standard work is not meant to be stagnant; but rather evolve as teams learn and optimize the work.
Although it is still unclear how much of the loosened reimbursement changes and privacy regulations will hang around after COVID-19, as we begin looking toward the future, virtual care will undoubtedly play a significant role in the way organizations across the country interact with and treat patients in the ambulatory environment.
It is important that organizations have a strategy to harness the technology and innovation to ensure we do not turn back the hands of time once the crisis subsides. Well-designed processes will enable great technology leading to high value, high quality, and highly reliable health care experiences for patients, doctors and care teams now and in the future.
There is no better time than the present to get started. Remember, think big and be bold - now is the time to re-design the future of healthcare.